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Michael Loy Gracia

Pediatrics

Allopathic & Osteopathic Physicians

3020 Childrens Way, San Diego, CA 92123-4223

PECOS Enrollment

This provider is enrolled in PECOS as MICHAEL GRACIA.

Based on the most recent information from CMS, provider Michael Loy Gracia is legally eligible to order and refer claims for Part B, HHA and DME services only.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 2:29 PM.

Profile Details

Provider ID
1023570215
Provider Type
Individual
Full Name
Gracia, Michael Loy
Title
Dr.
Credential
MD

Gender
Male
Sole Proprietor
No
Enumeration Date
4/5/2019
Last Updated
10/16/2024

Contact Information

Practice Location

3020 Childrens Way, San Diego, CA 92123-4223

(858) 966-5841

Unlisted Fax

Mailing Location

3020 Childrens Way # Mc5003, San Diego, CA 92123-4223

(858) 309-6300

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 208000000X Primary	Description Pediatrics Allopathic & Osteopathic Physicians	License A179553 California

Michael Loy Gracia

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

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Haddad, Gabriel George

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Todd, Sarah Catherine

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